Methods in Mentoring is a bimonthly column produced in partnership with the National EMS Management Association. Visit www.nemsma.org.
You receive a call from the quality person in your service, saying they need to talk to you and your partner about a call you responded to last shift. Your anxiety level spikes as you revisit everything that occurred and what you might have done wrong. You talk with your partner (who is equally anxious) and try to pinpoint a cause. Fear and anxiety grip you—what doom is pending?
Too often EMS systems have looked to their quality personnel to be the “enforcers” of EMS clinical practice. For years quality managers have been the correctors of mistakes, often with punitive results. Punitive practices have led to a common fear that discussion with quality managers means you’ve made a mistake or are in trouble.
In my early career, a quality manager seemed to be the individual who knew the most, whether it be operational procedures or difficult patient presentations. I believed they always knew the right answer and what I should do to improve.
As my career continued, I realized being a quality manager did not mean you had all the answers. It became apparent that being a good quality manager required being a champion for the field staff and a mentor. In quality we often become focused on processes and data analysis, forgetting the human component and need for mentorship. To be a quality improvement specialist, it’s equally important to be a quality mentor to the people you’re trying to help.
As managers, we are stewards of quality and responsible for helping facilitate the clinical and operational improvement of those around us. Mentoring for improvement can be a big undertaking, especially if you’ve not received adequate training or direction on how to perform QI work correctly. Truthfully, the key component to successfully stewarding quality is learning how to be a quality mentor for your agency. Based on experience, I have found five key components to succeeding as a mentor, especially in quality improvement.
To be a mentor, particularly in quality improvement, you have to know your mentee and what motivates them. No style will effectively work on every person. Therefore, it is important to have the skill to evaluate individuals and find their unique style.
Being a mentor can mean being a coach, a role model, a teacher, an advisor, a guide, and most often a peer. The quality manager should fulfill the individual’s needs. For example, if a crew member has recognized an error and needs to self-report, the quality manager should be an advisor, coach, and peer. The individual may require direction on how to properly self-report or may only be looking for someone to listen and coach them through the issue. A quality manager passing judgement on an individual without full information will lose that individual’s trust. Facts cannot be obtained without actively listening. It is imperative for quality managers to practice active listening and mindfulness when interacting with colleagues. Nothing can be accomplished without being mindful of the person’s hopes, fears, expectations, and needs.
Quality mentors must also be approachable. Approachability allows the opportunity to listen and build relationships with peers. Every mentor in my career has been someone who was approachable and reliable with a question or situation. Mentoring means being someone a mentee can come to and ask for guidance. Being too harsh, unavailable, or withdrawn will put anyone at unease.
Clear communication between mentor and mentee is critical in the success of mentoring. Leave time before and after your discussion for dialogue. Creating an environment of friendly discussion will bolster the trust individuals have in their quality manager.
Great managers also build relationships with others. Understanding what motivates an individual is important but means nothing without building a relationship based on trust, collaboration, and empathy.
Look back at the beginning of this article—why would those providers be so worried about talking to someone they trusted? Sadly, some quality managers fail to build a relationship of trust and understanding when discussing clinical cases with crews. If the crew feels like a visit with the quality manager is “going to the principal’s office,” the quality staff need to reestablish trust with the field providers.
Approaching discussions with providers in a Just Culture environment allows for trust, collaboration, and empathy to develop without judgement of the people involved. Always keep in mind the purpose of the quality manager position: to improve the quality of individuals, the service, and the profession. Trust is built over time, and repeated attempts may be needed before field providers feel comfortable discussing cases openly and actively.
If clinical reviews have been handled poorly, especially for a long time, it usually takes just as long to regain a trusting culture. The best advice is to regularly approach discussions by allowing the individuals to tell their story and present their case. Most of the time the crew already knows what issues occurred and is prepared to explain why events happened; they may just need assistance with how to improve for the future.
Dichotomy of Praise
Many mentees feel negative feedback is provided more abundantly than positive feedback. Everyone wants to improve, but they want their accomplishments recognized also. Praise for a good job is free and can be done in many ways. Recognition is a valuable tool that helps promote desired behaviors and incentivizes good performance. Quality managers should be generous with praise, letting people know they’ve performed excellent work when deserved.
Try to provide praise as close to the time of the event as possible. Praise given days or weeks afterward is still helpful, but immediate praise is more likely to connect with the mentee and influence behavior.
Quality managers should strive to guide those we mentor to solutions and goals that lead to their improvement. Empowering those we mentor establishes ownership of their improvement, making it more rewarding and meaningful. Tools to help guide those we precept to improve their performance are SMART goals (specific, measurable, attainable, relevant, time-based), action plans, and regular feedback.
Our purpose as mentors is not to be all-knowing, all-controlling leaders. We are mentors to provide guidance in the development of sound clinical practitioners. We must empower those we mentor to become self-sufficient providers and grow. This in turn will provide new mentors in the future, perpetuating the best practices our systems require. Empowering providers should always be the end goal of a quality manager.
Mark Price, EMT-P, is quality coordinator and a paramedic for the Cy-Fair Volunteer Fire Department in Cypress, Tex. He chairs the National EMS Management Association’s Quality Committee and is a committee member for the South-East Texas Regional Advisory Council for injury prevention, cardiac, stroke, and prehospital care.